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Articles by S Mishra
Total Records ( 5 ) for S Mishra
  P Gupta , H Rajeswari , M Arumugam , S Mishra , R Bhagavat , P Anand , N Chandra , R Srinivasan , S Indi and P. Ajitkumar

We examined whether C-terminal residues of soluble recombinant FtsZ of Mycobacterium tuberculosis (MtFtsZ) have any role in MtFtsZ polymerization in vitro. MtFtsZ-C1, which lacks C-terminal extreme Arg residue (underlined in the C-terminal extreme stretch of 13 residues, DDDDVDVPPFMRR), but retaining the penultimate Arg residue (DDDDVDVPPFMR), polymerizes like full-length MtFtsZ in vitro. However, MtFtsZ-C2 that lacks both the Arg residues at the C-terminus (DDDDVDVPPFM), neither polymerizes at pH 6.5 nor forms even single- or double-stranded filaments at pH 7.7 in the presence of 10 mM CaCl2. Neither replacement of the penultimate Arg residue, in the C-terminal Arg deletion mutant DDDDVDVPPFMR, with Lys or His or Ala or Asp (DDDDVDVPPFMK/H/A/D) enabled polymerization. Although MtFtsZ-C2 showed secondary and tertiary structural changes, which might have affected polymerization, GTPase activity of MtFtsZ-C2 was comparable to that of MtFtsZ. These data suggest that MtFtsZ requires an Arg residue as the extreme C-terminal residue for polymerization in vitro. The polypeptide segment containing C-terminal 67 residues, whose coordinates were absent from MtFtsZ crystal structure, was modeled on tubulin and MtFtsZ dimers. Possibilities for the influence of the C-terminal Arg residues on the stability of the dimer and thereby on MtFtsZ polymerization have been discussed.

  S Mishra , S Bhatnagar , D Gupta , Gaurav Nirvani Goyal , R Jain and H. Chauhan

Background. Mechanical ventilation in cancer patients is a critical issue The present prospective descriptive study was designed (1) to assess the patient population needing respirator support in ward setting at a premier state-run oncology institute in India, (2) to observe and analyze the course of their disease while on respirator, and (3) to coordinate better quality of life measures in cancer patients at the institute based on the present study's outcomes.

Methods. Beginning from March 2005 to March 2006, all cancer patients who were connected to respirator in the wards were enrolled in the current study. Our anesthesiology department at the cancer institute also has primary responsibility for airway management and mechanical ventilation in high dependency units of oncology wards. Preventilation variables in cancer patients were assessed to judge the futility of mechanical ventilation in ward setting. Subsequently, patients were observed for disease course while on respirator. Final outcome with its etio-pathogenesis was correlated with predicted futility of mechanical ventilation.

Results. Over a period of 1 year, 132 (46 men and 86 women) cancer patients with median age 40 years (range 1-75 years) were connected to respirator in oncology wards. Based on the preventilation variables and indications for respirator support, right prediction of medical futility and hospital discharge was made in 77% of patients. Underestimation and overestimation of survival to hospital discharge was made in 10% cases and 13% cases, respectively.

Conclusion. Based on preventilation variables, prediction of outcome in cancer patients needing respirator support can be made in 77% cases. This high probability of prediction can be used to educate patients, and their families and primary physicians, for well-informed and documented advance directives, formulated and regularly revised DNAR policies, and judicious use of respirator support for better quality-of-life outcomes.

  A Ahmed , H Khurana , V Gogia , S Mishra and S. Bhatnagar

According to World Health Organization (WHO), cancer pain can be controlled effectively with oral morphine in up to 90% of patients. Due to advancement in anticancer therapy and early presentation of cancer patients, the likelihood of cure is on an increasing trend. Awareness and education in the use of oral morphine, and easier regulations in procurement of oral morphine for use in cancer pain has lead to prescription of oral morphine to more patients earlier in pain therapy. In many patients, resolution of disease occurs and it becomes necessary to withdraw morphine. Guidance for starting medications is fairly easily obtained, but it is difficult to find information about switching or discontinuing opioids. The initial decrease in dose is well tolerated by the patient but the last few steps of complete withdrawal are difficult. We present 2 cases where the sustained release oral morphine was used as a bridge to withdraw immediate release oral morphine successfully in 2 patients after resolution of disease.

  S Mishra and Shiv Pratap Singh Rana

The complexity of pain and pain care is such that there may come a point in the treatment of a patient with pain when a simple approach to management is no longer possible. The proverbial analgesic ladder can be rapidly overtaken when attempting palliative management of long-term or severe end-of-life pain. Epidural steroid injection is frequently used procedure in chronic back pain of neuropathic origin in nonmalignant cases. This case report implicates the use of epidural steroid for the management of severe neuropathic symptoms including allodynia and hyperalgesia in the setting of cancer pain and palliative care.

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